title: Cerebral blood flow and the injured brain: how should we monitor and manipulate it?
abstract: OBJECTIVE
  Cerebral ischemia plays a major role in the pathophysiology of the injured brain, including traumatic brain injury and subarachnoid hemorrhage, thus improvement in outcome may necessitate monitoring and optimization of cerebral blood flow (CBF). To interpret CBF results in a meaningful way, it may be necessary to quantify cerebral autoregulation as well as cerebral metabolism. This review addresses the recent evidence related to the changes in CBF and its monitoring/management in traumatic brain injury.
  
  
  RESULTS
  Recent evidence on the management of patients with traumatic brain injury have focused on the importance of cerebral autoregulation in maintaining perfusion, which necessitates the measurement of CBF. However, adequate CBF measurements alone would not indicate the amount of oxygen delivered to neuronal tissues. Technologic advancements in measurement devices have enabled the assessment of the metabolic state of the cerebral tissue for the purpose of guiding therapy, progress as well as prognostification.
  
  
  CONCLUSIONS
  Current neurocritical care management strategies are focused on the prevention and limitation of secondary brain injury where neuronal insult continues to evolve during the hours and days after the primary injury. Appropriately chosen multimodal monitoring including CBF and management measures can result in reduction in mortality and morbidity.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
authors.forename: Armagan
authors.initials: A
authors.lastname: Dagal
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Lam
mesh_terms: D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D017551:Microdialysis; D008991:Monitoring, Physiologic; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology; D010346:Patient Care Management; D049268:Positron-Emission Tomography; D012212:Rheology; D019265:Spectroscopy, Near-Infrared; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial